TY - JOUR
T1 - Caregiver-oncologist prognostic concordance, caregiving esteem, and caregiver outcomes
AU - Loh, Kah Poh
AU - Watson, Erin
AU - Culakova, Eva
AU - Flannery, Marie
AU - Sohn, Michael
AU - Xu, Huiwen
AU - Kadambi, Sindhuja
AU - Magnuson, Allison
AU - McHugh, Colin
AU - Sanapala, Chandrika
AU - Kehoe, Lee
AU - Vogel, Victor G.
AU - Burnette, Brian L.
AU - Vinciguerra, Vincent
AU - Mohile, Supriya G.
AU - Duberstein, Paul R.
N1 - Funding Information:
The work was supported by the Patient-Centered Outcomes Research Institute (PCORI) Program contract (4634 to SGM), the National Cancer Institute at the National Institute of Health ( UG1 CA189961 ); R01CA168387 to PRD; K99CA237744 to KPL), the National Institute of Aging at the National Institute of Health ( K24 AG056589 to SGM; R33 AG059206 to SGM; K76 AG064394 to AM), and the Wilmot Research Fellowship Award (grant number is not applicable; to KPL). This work was made possible by the donors to the Wilmot Cancer Institute (WCI) geriatric oncology philanthropy fund. All statements in this report, including its findings and conclusions, are solely those of the authors, do not necessarily represent the official views of the funding agencies, and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI) , its Board of Governors, or Methodology Committee.
Publisher Copyright:
© 2022 Elsevier Ltd
PY - 2022/7
Y1 - 2022/7
N2 - Introduction: Caregiver-oncologist concordance regarding the patient's prognosis is associated with worse caregiver outcomes (e.g., depressive symptoms), but mechanisms underpinning these associations are unclear. We explored whether caregiving esteem mediates these associations. Methods: At enrollment, caregivers and oncologists used a 5-point ordinal scale to estimate patient survival; identical responses were considered concordant. At 4–6 weeks, caregivers completed an assessment of the extent to which caregiving imparts self-esteem (Caregiver Reaction Assessment self-esteem subscale; range 0–5; higher score indicates greater esteem). They also completed Patient Health Questionnaire-2 (PHQ-2) for depressive symptoms, Distress Thermometer, and 12-Item Short Form Survey for quality of life (QoL). Mediation analysis with bootstrapping (PROCESS macro by Hayes) was used to estimate the extent to which caregiving mediated the effects of prognostic concordance on caregiver outcomes through caregiving esteem. Results: Prognostic concordance occurred in 28% the caregiver-oncologist dyads; 85% of the discordance were due to caregivers estimating a longer patient's survival. At 4–6 weeks, mean caregiving esteem score was 4.4 (range 1.5–5.0). Lower caregiving esteem mediated the associations of concordance with higher PHQ-2 [indirect effect = 0.12; 95% Confidence Interval (CI) 0.03, 0.27], greater distress (indirect effect =0.25; 95% CI 0.08, 0.48), and poorer QoL (indirect effect = −1.50; 95% CI −3.06, −0.41). Caregiving esteem partially mediated 39%, 64%, and 48% of the associations between caregiver-oncologist concordance and PHQ-2, distress, and SF-12, respectively. Conclusions: Caregiver-oncologist concordance was associated with lower caregiving esteem. Lower caregiving esteem mediated the negative relationship between caregiver-oncologist concordance and caregiver outcomes.
AB - Introduction: Caregiver-oncologist concordance regarding the patient's prognosis is associated with worse caregiver outcomes (e.g., depressive symptoms), but mechanisms underpinning these associations are unclear. We explored whether caregiving esteem mediates these associations. Methods: At enrollment, caregivers and oncologists used a 5-point ordinal scale to estimate patient survival; identical responses were considered concordant. At 4–6 weeks, caregivers completed an assessment of the extent to which caregiving imparts self-esteem (Caregiver Reaction Assessment self-esteem subscale; range 0–5; higher score indicates greater esteem). They also completed Patient Health Questionnaire-2 (PHQ-2) for depressive symptoms, Distress Thermometer, and 12-Item Short Form Survey for quality of life (QoL). Mediation analysis with bootstrapping (PROCESS macro by Hayes) was used to estimate the extent to which caregiving mediated the effects of prognostic concordance on caregiver outcomes through caregiving esteem. Results: Prognostic concordance occurred in 28% the caregiver-oncologist dyads; 85% of the discordance were due to caregivers estimating a longer patient's survival. At 4–6 weeks, mean caregiving esteem score was 4.4 (range 1.5–5.0). Lower caregiving esteem mediated the associations of concordance with higher PHQ-2 [indirect effect = 0.12; 95% Confidence Interval (CI) 0.03, 0.27], greater distress (indirect effect =0.25; 95% CI 0.08, 0.48), and poorer QoL (indirect effect = −1.50; 95% CI −3.06, −0.41). Caregiving esteem partially mediated 39%, 64%, and 48% of the associations between caregiver-oncologist concordance and PHQ-2, distress, and SF-12, respectively. Conclusions: Caregiver-oncologist concordance was associated with lower caregiving esteem. Lower caregiving esteem mediated the negative relationship between caregiver-oncologist concordance and caregiver outcomes.
KW - Caregiver
KW - Depressive symptom
KW - Distress
KW - Prognostic understanding
KW - Quality of life
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U2 - 10.1016/j.jgo.2022.02.018
DO - 10.1016/j.jgo.2022.02.018
M3 - Article
C2 - 35277372
AN - SCOPUS:85125906146
SN - 1879-4068
VL - 13
SP - 828
EP - 833
JO - Journal of Geriatric Oncology
JF - Journal of Geriatric Oncology
IS - 6
ER -